How Can Insurance Providers Speed Up Claims Processing Using Digital Technology?

Claims processing is, by a large margin, one of the most time-consuming, labor-intensive, and costly processes an insurance company performs as part of its regular operations. For many companies, this process is spread out across multiple discrete systems and involves the participation of different business units.

Some insurance companies also depend on out-of-date technological infrastructure to cut back on replacement costs. Taken collectively, these adverse conditions surrounding claims processing can compromise both the quality and timely delivery of claims, leading to negative customer experiences and diminished client satisfaction overall.

Exhausting every possible avenue to speed up claims processing, however, is extremely beneficial both to insurance companies and their clientele. A vast majority of insurance policyholders cite speedy settlements as their primary criterion for a positive claims processing experience. Faster claims processing not only improves customer satisfaction and retention rates, but also lowers operational expenditure for the company and enables more efficient operations on the whole.

In pursuit of these clear benefits, many insurance providers now make use of insurance software to save time and labor costs, as well as to safeguard claims against human error incidents and other setbacks. An automated, digital approach to claims processing using state-of-the-art software can benefit insurance companies in a host of ways, including:

Streamlined Pricing Methods

Good insurance software will support a broad array of pricing methods, including but not limited to bundled amounts, payment functions, fee schedules, and the like. It should likewise offer equally extensive support of different business rule types—such as limit rules, encounter rules, simple and combination adjustment rules, and others—in order to calculate insurance prices fairly and accurately.

These functions can then be applied as needed to set templates within the software and used to produce clean and comprehensive provider contracts in a fraction of the time it would take to draw up such contracts manually. The use of digital software also ensures that all data used in contract configuration, such as claims pricing results and relevant payment calculations, is documented and completely traceable within the system.

Automated Claims Processing

The automated adjudication insurance software is able to perform allows for individual claims to be processed in real time rather than in batches. Automation of this process works to reduce labor costs, processing time, and the incidence of human error for all claims. With the use of intelligent and well-configured software, providers can then naturally expect improvements to information quality as well.

Most iterations of insurance software validate claims according to a preconfigured process encoded within the system, but authorized users may also modify the system’s behaviors and functions as necessary at different points in the claims flow. Once the adjudication is concluded, the software is immediately able to produce a complete copy of the finalized claim, as well as a fully traceable record of all applied rules and decisions utilized in the processing of each request. Adjudicated claims can also be sent to and integrated with relevant external providers for real-time synchronization.

Scalable Operations to Handle Large Amounts of Data

The best insurance software will be able to scale its performance according to the amount of work it needs to accomplish. Mass-reprocessing of claims, for example, and other processes involving the handling of a high volume of information should be possible with the appropriate software. Likewise, the software can automatically bundle related claims together for more efficient processing. These capabilities will, in turn, serve to lower operational costs and reduce the need for customized IT solutions and the additional labor necessary to provide these.

User-Friendly Product Definition

Digital insurance management systems allow users to easily differentiate between the variety of products on offer from the company and also expedite the timely rollout of new product offerings. These systems can be integrated with both government and private exchanges in order to further facilitate the process of putting these new products on the market. Besides improving product rollout, easy product definition through digital software also makes for smoother enrollment, contract configuration, and billing processes.

Integrated Management of Authorizations and Referrals

Insurance software consolidates the management of all authorizations and referrals required in the process of validating claims within a single system. The software is able to receive all required authorizations from the necessary entities and key them directly into the system in real time. Making use of the software thus reduces the risk of incurring pending claims due to mismatched or erroneous authorizations and further serves to cut processing costs.

Employing up-to-date technology is vital to the success of any insurance provider. Depending on its current situation and needs, a company may elect to pursue a fully overhauled, entirely automated system of claims management or simply choose to automate a few of its key processes. At every turn, it remains important for an insurance company’s leadership to investigate current efficiency gaps thoroughly in order to explore appropriate digital solutions.